,^jKtioy\, 


DUPLICATE 

I'iriiiiiiiiiiii 

HXOOO 17965 


Frederic  S>  Lee 
Golunibia  Univr- 
New  York 


CONFERENCE  ON  INDUSTKIAL  HYGIENE 


THE   ROCKEFELLER  FOUNDATION 
61   BROADWAY.  NEW  YORK.  U.  S.  A. 


^£3L2l 


cnk 


Columbia  ©nitiersJitp 
intI)r€itpoflrtritork 

College  of  J^hV^imni  avib  ^urgeoncc 

ILifararp 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/conferenceoninduOOrock 


1. 


B 


CONFERENCE  ON  INDUSTRIAL  HYGIENE 
Held  at  the  Yale  Club  in  New  York  City,  November  14,  1919, 
Upon  Invitation  of  the  Officers  of  the  Rockefeller  Foundation* 


THE  FIELD 
The  following  facts  bearing  upon  the  field  of  industrial 
hygiene,  which  at  once  suggest  the  occasion  for  and  the  setting  of  this 
conference,  were  outlined  in  memoranda  submitted  by  persons  invited  to 
the  conference  and  were  presented  as  the  basis  and  the  guide  for  the  dis- 
cussion: 

1.  There  are  at  present  in  the  United  States  over  900  corporations 

which  employ  more  than  1,500  industrial  physicians,  most  of 
whom  are  said  to  be  on  a  full-time  basis.  The  DuPont- 
Nemours  Company  is  reported  to  employ  more  than  50  physicians, 
the  International  Harvester  Compeuiy  40,  and  the  Goodrich  Rub- 
ber Company,  of  Akron,  Ohio,  more  than  20.  Among  the  other 
corporations  that  have  adopted  medical  systems  that  have 
attracted  attention  are  the  following:   United  States  Steel 
Company;  Tennessee  Coal  and  Iron  Company;  American  Telephone 
and  Telegraph  Company;  The  Norton  Company,  of  Worcester. 
Uassachuaetts . 

2.  The  Association  of  Industrial  Physicians  and  Surgeons  meets  an- 

nually and  is  reported  to  have  a  membership  of  ov^r  100. 

S.  Existing  and  pending  health  insurance  legislation  is  a  problem 
in  industrial  hygiene. 

4.   Research  in  industrial  fatigue  seems  necessary  to  a  solution  of 
many  fundamental  problems  of  industry. 


Qovernment  Agencies 

6.  Government,  state,  and  municipal  agencies  are  meeting  various 
phases  of  the  industrial  hygiene  needs: 

The  United  States  Public  Health  Service  has  appointed  a  corps 
of  industrial  physicians  to  make  studies  in  manufacturing 
olants  in  various  parts  of  the  country. 


*NOTE:  The  officers  or  the  Rockefeller  Foundation  felt  that  such  a 

conference  would  suggest  and  clarify  many  problems  in  connection 
with  this  important  topic  in  tha  general  field  of  public  health. 
It  has  not  appeared  feasible  for  the  Foundation  to  undertake 
definite  programs  in  industrial  hygiene. 


2. 


The  Pennsylvania  State  Department  of  Labor  and  Industry  has  a 

Division  of  Industrial  Hygiene  and  Engineering. 
The  New  York  City  Health  Depeo'tment  has  appointed  a  number  of 

industrial  physicians  and  is  developii\g  various  phases  of 

the  field. 
In  Newark  there  is  a  municipal  clinic  for  industrial  diseases. 
At  Perth  Amboy  there  is  a  similar  clinic  conducted  by  the 

United  States  Public  Health  Service. 
No  doubt  there  are  many  other  similar  agencies  in  various 

parts  of  the  United  States. 


Existing  Training  Facilities 

6.  Lectures  or  courses  in  industrial  hygiene  and  occupational 

diseases  are  given  at  the  following  institutions:   Cincinnati 
Medical  College;   Harvard-Massachusetts  Institute  of  Technology; 
Johns  Hopkins  School  of  Hygiene  and  Public  Health;  Museum  of 
Safety,  New  York  City  (course  of  lectures  on  "Safety  Funda- 
mentals");  Rush  Medical  College;   State  University  of  Ohio; 
University  of  Pennsylvania;   Yale  University. 

7.  There  is  thus  far  in  this  country  no  institution  which  has  the 

combination  of  an  Industrial  Hygiene  School  with  a  hospital 
for  the  highly  specialized  care  required  for  industrial 
injuries  sind  occupational  diseases,  in  which  facilities  are 
available  for  training  and  research* 


s. 


TOPICS  SUGGESTED 


1.  Is  there  need  for  additional  teaching  facilities  in  industrial 

hygiene? 

a.  How  many  industries  employ  physicians? 

b.  How  many  employ  full-time  physicians;  how  msmy  employ 

part-time  physicians? 

c.  How  many  hiehly  trained  men  can  the  field  absorb? 

2.  Teaching  of  industrial  hygiene, 

a.  What  are  the  existing  facilities  for  training  industrial 

physicians? 

b.  Can  industrial  hygiene  be  adequately  taught  as  a  depart- 

ment of  a  public  health  school? 

c.  Is  a  separate  institute  necessary? 
d*  What  courses  should  be  given' 

e.  Should  medical  and  surgical  relief  peculiar  to  industrial 

conditions  be  taught  in  a  separate  hospital? 
Should  such  a  hospital  be  a  part  of  a  school? 

f.  Should  there  be  a  hospital  and  dispensary  for  the  treat- 

ment of  occupational  diseases  and  injuries? 

3.  What  should  be  the  objective? 

a.  Should  the  course  of  training  be  Sufficiently  complete 

to  lead  to  a  degree? 

b.  Should  there  be  short  intensive  courses  for  those  already 

employed  as  industrial  hygiene  doctors? 
c*   Should  there  be  a  research  department? 

d.  Should  the  field  of  the  safety  engineer  be  covered  in  the 

curriculum? 

e.  Should  there  be  special  training  provided  for  industrial 

nurses?  For  laymen  to  fill  positions  corresponding 
to  hospital  steward  and  sanitary  inspector? 

f.  Should  field  investigations  and  special  studies  in  in- 

dustrial plants  be  provided? 

g.  Should  there  be  provision  for  public  education  in  indus- 

trial hygiene  through  lectures,  literature,  demon- 
strations, visiting  nurses,  etc.? 

h.   Should  effort  be  made  to  starKlardize  the  medical  equipment, 
quarters,  facilities,  etc.,  in  industrial  plants? 

i.  What  provision  should  be  made  to  meet  the  requirements  of 
health  insurance  legislation? 

j.   Should  steps  be  taken  to  standardize  the  sanitary  con- 
struction of  factory  buildinz;8  and  appurtenances? 

k.   Should  publications  be  issued  embodyini?;  the  results  of 

special  pieces  of  research,  standards  of  industrial 
hygiene,  eto.? 

4.  How  3hould  the  teaching  of  industrial  hygiene  be  organized?  What 

departments  should  it  embrace? 

6.   To  insure  attendance  will  it  be  necessary  to  provide  soholarthips 
and  fellowships? 


4. 


PERSONMEL  OF  THE  CONFERENCE 


Prof.  Charles  Baskerville, 

College  of  the  City  of  New  York, 
American  Chemical  Society. 

Dr.  Hermann  M.  BigjB, 

New  York  State  Dept.  of  Health. 

Dr.  W.  Irving  Clark,  Jr., 

Norton  Company,  Worcester,  Mass. 

Dr.  Cecil  K.  Drinker, 

Dept.  of  Industrial  Hygiene, 
Harvard-Mass.  Inst,  of  Tech. 

Dr.  David  L.  Edsall, 

Harvard  Medical  School, 
Dept.  of  Industrial  Hygiene, 
Harvard-Mass.  Inst,  of  Tech. 

Dr.  William  A.  Howe, 

(Representing  Dr.  John  H.  Finley) 
Board  of  Regents,  State  of  N.Y. 

Dr.  Simon  Flexner, 

Rockefeller  Institute  for  Medical 
Research. 

Dr.  C.  E.  Ford, 

General  Chemical  Company. 

Dr.  Otto  P.  Geier, 

Cincinnati  Killing  Company. 

Dr.  Emery  R.  Hayhurst, 

Division  of  Industrial  Hygiene, 
Ohio  State  Dept.  of  Health. 

Dr.  Frederic  S.  Leo, 

Physiologist,  Columbia  University. 

Dr.  Thomas  K.  Leggo , 

Medical  Inspector  of  Factories, 
London,  England. 


Dr.  J.  W.  Schereschewsky, 
Assistant  Surgeon  General, 
U.S.  Public  Health  Service, 
In  charge  of  Industrial  Hygiene. 

Dr.  Renold  A.  Spaeth, 

School  of  Hygiene  and  Public  Health 
Johns  Hopkins  University. 

Dr.  W.  Gilman  Thompson, 

Clinic  for  Functional  Re-education, 
New  York,  N.  Y. 

Vx.   C-E.  A.  Viinslow, 

Professor  of  Public  Health, 
Yale  University, 


And  the  following  from  the  Rockefeller 
Foundation: 

Mr.  George  E.  Vincent, 

President  of  the  Rockefeller  Foundation. 

Mr.  John  D.  Rockefeller,  Jr., 

Chairman  of  Board  of  Trustees  of  the 
Rockefeller  Foundation. 

Mr.  Wickliffe  Rose, 

Director  of  the  International  Health 
Board  of  the  Rockefeller  Foundation. 

Dr.  Victor  G.  Reiser, 
Director  for  the  East, 
International  Health  Board  of  the 
Rockefeller  Foundation. 

Mr.  Edwin  R.  Embree. 

Secretary  of  the  Rockefeller  Foundation. 

Ur.  Charles  Cason, 

The  Rockefeller  Foundation. 


Dr.  T.  Mitchell  Prudden, 

Rockefeller  Institute  for  Itodioal 
Research. 


SUMMARY  OF  THE  CONFERENCE 

Mr.  George  E.  Vincent,  Presiding: 

From  several  different  sources  requests  have  been  made 
to  the  Rockefeller  Foundation  to  cooperate  in  different  phases 
of  industrial  hygiene .  This  subject  falls  within  the  field  of 
public  health  to  which  the  Foundation  is  giving  special  attention. 
In  view  of  the  fact  that  industrial  hygiene  or  oiedicine  is  a  new 
and  rapidly  developing  department  of  public  health  work,  it  has 
seemed  desirable  to  the  officers  of  the  Foundation  to  call  this 
conference  of  men  recognized  as  leaders  in  this  movement.   I  de- 
sire to  express  appreciation  of  your  acceptance  of  our  invitation. 

By  way  of  opening  the  subject  I  propose  to  call  upon  a 
group  of  men  who  are  familiar  with  the  practical  aspects  of  indus- 
trial hygiene  and  then  upon  several  representatives  of  the  special 
training  which  is  being  provided  for  workers  in  this  field.  A 
syllabus  or  outline  has  been  prepared  as  a  basis  for  discussion. 
This  incorporates  the  suggestions  which  have  been  solicited  in  ad- 
vance from  those  who  were  invited  to  attend  this  meeting. 


6. 


Dr.  J.  W.  Schereschewsky: 

It  is  a  matter  of  great  pleasure  to  me  to  be  able  to  be 
present  at  this  meeting, because  it  is  an  earnest  of  the  vei^  great 
Interest  which  this  problem  is  presenting  to  those  who  are  studying 
the  needs  of  the  country,  and  it  marks  a  stepping  stone  in  the  prog- 
ress which  I  trust  we  will  see  in  the  next  few  years.   To  those  who 
have  looked  into  this  matter  of  industrial  hygiene,  it  is  evident 
there  is  urgent  need  for  very  great  improvement  in  the  situation. 

There  are  some  45,000,000  occupied  persons  in  the  United 
States,  of  which  25,000,000  may  be  classified  as  industrial  workers. 
There  is  enormous  economic  loss  because  of  preventable  illness.  We 
are  faced  at  this  time  with  the  necessity  for  prevention.   The  war 
has  taught  us  the  great  value  of  mem  power  to  the  nation,  but  a  large 
amotuit  of  man  power  is  wasted  because  of  ill  health  which  is  prevent- 
able  If  we  are  to  improve  industrial  conditions  we  must  direct  at- 
tention to  industrial  health. 

One  of  the  best  means  for  promoting  industrial  health  is 
the  establishment  of  what  may  be  best  called  industrial  health  ser- 
vice  One  of  the  best  things  industry  can  do  for  Itself  is  the  main- 
tenance of  a  continuous  state  of  health  in  workers   The  ability  to 
supply  health  service  is  a  most  fascinating  problem,  for  the  reason 
that  nowhere  else  do  we  have  a  group  of  people  so  ready  at  hand  to 
influence  toward  better  health  than  exist  in  industry.  We  must 
ascribe  a  certain  portion  of  the  present  condition  of  industrial  un- 
rest to  ill  health.  When  we  consider  this  problem  It  Is  one  of  ex- 


7. 

Dr.  Seheresehewsky  -  Cont'd: 

treine  conolexity  because  it  requires  the  co-ordinated  efforts  of  in- 
terlocking agencies,  such  as  educational  forces,  the  national  govern- 
ment, the  state  goverranents,  the  general  public.   The  industrial 
worker,  too,  is  himself  responsible  to  a  certain  extent  for  improv- 
ing his  own  health. 

The  Public  Health  Service  in  its  study  of  this  question  has 
brought  out  a  program  for  the  general  improvement  of  national  health 
in  which  improvement  in  industrial  health  plays  an  important  part. 
The  object  of  this  program  is  to  outline  what  the  federal  government 
may  do  to  stimulate  such  improvement.   The  federal  governmental  powers 
are  advisory,  investigative  and  co-operative.   The  states  are  to  be 
regarded  as  the  agencies  which  will  place  into  operation  the  police 
powers  of  the  people  to  aid  in  framing  regulations  and  in  insuring 
uniform  conditions  throughout  the  country.   The  pert  that  educational 
institutions  may  play  is  to  furnish  the  necessary  personnel  to  carry 
out  such  a  progreun.   The  most  important  thing  in  the  development  of 
a  program  of  industrial  hygiene  is  necessarily  the  personnel  which 
puts  it  into  effect.  We  have  in  Industrial  Health  Service  a  means 
whereby  capital  euid  labor  nay  meet  on  a  comnon  ground.   It  beoomes  a 
means  of  revealing  the  identity  of  their  interests.   It  is  susceptible 
of  forming  one  of  the  most  potent  agencies  which  we  can  devise  for 
walding  Society  into  a  harmonious  whole. 

We  are  now  ready  as  a  nation  to  go  very  deeply  into  the 
funeral  promotion  of  public  health.  It  is  therefore  necessary  to 
develop  at  the  earliest  possible  moment  a  national  protcram  for  the 


8. 

Dr.  Scheresehewsky  -  Cont'd: 

Improvement  of  industrial  health  in  which  all  shall  play  a  co-ordi- 
nate part.  When  this  is  done  that  will  be  the  basis  for  educational 
facilities  in  order  to  carry  out  the  progreim  which  has  been  mapped 
out.   The  program  so  far  as  the  federal  government  is  concerned  is  a 
large  extending  of  the  service,  much  larger  than  has  been  in  the 
past,  and  to  extend  it  to  cover  the  whole  country.  There  are  re- 
quired to  be  made  mini mum  standards  of  industrial  health;  there 
should  be  means  provided  for  the  reporting  of  industrial  morbidity 
and  mortality  statistics;  steps  should  be  taken  to  improve  the  sani- 
tation of  industrial  communities.  The  federal  governaient,  therefore, 
should  furnish  the  leadership  and  should  co-operate  with  the  states 
in  performing  these  general  duties  which  I  have  outlined.  So  far  as 
the  state  is  concerned  it  should  provide  the  necessary  machinery  and 
organisation  to  really  enforce  proper  regulations  for  community  and. 
factory  sanitation. 

In  the  organisation  of  inspectors  of  factories  this  coimtry 
differs  greatly  from  foreign  countries.  The  requirements  of  factory 
inspectors  abroad  is  very  much  higher.  So  far  as  industry  is  concern- 
ed, it  owes  it  to  the  workers  to  provide  decent  working  conditions. 
The  worker  should  make  use  of  all  facilities  which  have  been  provided 
for  the  improvement  of  his  health. 


9. 


Dr.  Thomas  M.  Legge : 

Mr.  Chaim&n,  Dr.  Schereschewsky  has  pointed  out  and  voiced 
the  feelings  of  us  all  as  to  the  importance  of  this  gathering.  As  I 
have  had  unique  opportunities  in  Great  Britain  of  studj^ing  industrial 
conditions  and  their  effect  on  the  -workers  themselves,  I  would  like 
to  give  you  the  results,  in  part  at  least,  of  my  experience. 

I  have  held  the  position  of  medical  inspector  of  factories 
for  21  years,  and  for  12  years  of  that  time  I  worked  single-handed. 
Since  then  I  have  had  b  colleague,  and  just  before  I  left  for  America 
a  third  colleague  was  appointed.  But  all  this  time  I  have  been  in 
touch  with  the  Certifying  Factory  Surgeons  appointed  throughout  the 
country  by  the  Chief  Inspector  of  Factories.  Othei-v/ise  my  task  would 
have  been  impossible.  The  most  useful  thing  I  can  do  perhaps  is  to 
go  rapidly  through  the  agenda  and  give  you  my  views  on  the  several 
items  as  they  might  apply  in  Great  Britain. 

We  have  not,  as  you  have  in  America,  a  very  large  number 
of  full  time  physicians.   Indeed  until  the  war  I  do  not  suppose  there 
were  more  than  a  dozen  large  firms  in  Great  Britain  employing  a  full 
time  physician.  During  the  war,  however,  nearly  all  the  plants  em- 
ploying more  than  2,000  workers  would  have  one,  two,  or  three  full 
time  medical  men  or  women. 

There  is  no  question  whatever  as  to  the  need  of  additional 
teaching  facilities.  My  own  feeling  is  that  t}iere  should  be  no  water 
tight  departments  in  regard  to  training  and  teaching  in  industrial 
medicine.   It  is  a  matter  of  general  medicine  and  surgery.  The  more 
you  can  bring  that  knowledge  to  bear  in  the  training  of  the  medical 


Dr.  Legge  -  Cont'd:  W» 

stuflent  so  much  the  better.   There  muBt  be  specialists ,  but  they 
also  should  be  closely  associated  with  the  medical  schools.   It 
would  be  a  mistake,  in  my  opinion,  to  set  up  an  independent  insti- 
tute for  the  training  of  industrial  physicians  and  surgeons. 

In  Great  Britain  the  facilities  for  teaching  industrial 
hygiene  are  extremely  limited.   I  should  think  there  are  fewer  facil- 
ities there  than  in  America.  Only  one  university  has  taken  up  the 
subject  at  all,  that  is  the  University  of  Manchester.   In  Great 
Britain,  in  addition  to  the  general  medical  course,  we  make  it  a 
necessity  that  in  a  town  with  50,000  inhabitants  or  more  the  medical 
officer  of  health  must  hold  a  special  diploma  in  public  health  for 
which  attendance  at  a  postgraduate  course  lasting  six  months  is  neces- 
sary and  is  supposed  to  include  a  knowledge  of  occupational  diseases. 
In  addition  to  the  teaching,  the  post  graduate  who  enters  on  this 
course  must  spend  six  months  with  a  medical  officer  of  health.   This 
six  months  is  largely  a  waste  of  time;   they  do  not  need  so  long  a 
time.   The  General  Wedical  Council  made  it  possible  for  universities 
giving  this  course  to  limit  the  amount  of  time  spent  with  a  medical 
officer  of  health  to  three  months  provided  that  during  the  other 
three  months  additional  instruction  were  given,  and  at  Manchester 
University  they  elected  to  give  courses  in  factory  and  school  hygiene 
and  veterinary  hygiene.  About  1908  I  was  asked  to  lecture  on  factory 
hygiene.   That  I  have  done  since  then  except  for  three  years  during 
the  war.   I  only  give  six  lectures  during  the  summer.   That  is  a  very 
meagre  amount  of  teaching.   However,  all  lectures  are  of  two  kinds: 


Dr.  Legge  -  Cont'd:  21 

first,  those  that  actually  teach,  and  secondly,  those  that  are  in- 
tended to  stimulate  interest,  and  all  I  can  do  is  to  give  lectures 
which  try  to  stimulate.   These  lectures  cover  briefly: 

1.  The  statutory  duties  of  the  medical  practitioner  in 

regard  to  industrial  diseases  and  their  duties  in 
regard  to  the  irorkman's  compensation  act. 

2.  General  hygiene  of  the  factory. 

3.  Special  hygiene  of  the  factory. 

4.  Industrial  fatigue. 

5.  A  description  more  particularly  of  the  notifiable  dis- 

eases. 

6.  Other  diseases  scheduled  under  the  ■workman's  compensa- 

tion act. 

I  certainly  believe  that  industrial  hygiene  can  be  taught 
adequately  as  a  department  of  a  Public  Health  course  provided  that 
the  public  health  school  is  associated  with  a  general  hospital  and 
that  the  clinioal  side  of  medicine  is  never  left  out  of  sight.  Any- 
thing that  divorces  a  medical  man  from  the  practice  of  medicine  is 
to  me  a  most  deplorable  thing.   I  hope  that  industrial  hygiene  will 
not  fall  into  the  hands  of  the  public  health  service  which  is  con- 
cerned solely  with  administrative  matters  and  is  not  directly  con- 
nected with  clinical  practice. 

On  the  question  of  whether  medical  and  surgical  relief 
peculiar  to  industrial  conditions  should  be  taught  in  a  separate  hos- 
pital, I  an  decidedly  of  the  opinion  that  it  is  better  not  to  teach 
it  in  a  separate  hospital,  but  that  all  facilities  should  be  centered 
in  a  general  hospital  where  special  emphasis  can  be  given  to  occupa- 
tional diseases. 

Should  there  be  a  hospital  and  dispensary  for  the  troatmen* 
of  occupational  diseases  and  injuries':'   There  again  I  teJce  the  same 


Dr.  Legge  -  Cont'd:  12, 

view.  No,  but  naturally  special  importance  would  be  given  to  them 
in  dispensaries  in  districts  where  occupational  diseases  are  most 
likely  to  be  met  with. 

Should  the  course  of  training  be  sufficiently  complete  to 
lead  to  a  degree?   I  should  strongly  oppose  this.   I  am  not  in  favor 
of  a  degree  being  specially  given  in  industrial  medicine.  I  should 
be  quite  willing  for  a  certificate  to  be  given,  but  I  should  not  like 
to  see  em  M.D.  granted  in  industrial  hygiene  alone. 

I  quite  agree  that  there  should  be  short,  intensified, 
courses  to  bring  industrial  surgeons  together  and  advance  their  know- 
ledge, and  a  research*  department  would  be  one  of  the  things  I  should 
regard  as  essential.   Practically  all  the  teaching  of  industrial  hy- 
giene can  be  centered  around  a  research  department.  As  an  example 
of  the  utility  of  research  I  may  say  that  we  failed  appreciably  to 
check  anthrax  before  and  during  the  period  of  the  war.  We  have  re- 
duced its  mortality  because  we  have  better  methods  of  treatment,- the 
product  of  research — but  we  had  not  given  as  much  thought  and  reseerch 
to  the  cause  as  to  the  effects  of  the  disease.  A  committee  appointed 
by  the  British  Government  carried  out  acme   very  searching  experiments 
during  the  war  with  a  view  to  discovering  if  possible  a  means  of  des- 
troying anthrax  spores  in  wool  -  the  principal  industry  affected. 
After  some  130  experiments  this  Coinnittee  definitely  proved  that  an- 
thrax spores  in  wool  could  be  destroyed  by  a  method  they  devised  with- 
out damaging  tlie  material  for  manufacturing  purposes.   The  British 
Government  is  a  practical  one  when  it  is  given  a  direct  lead,  so  we 


Dr.  Legge  -  Cont'd:  X8, 

are  now  arranging  to  erect  a  trial  disinfecting  station  in  Liverpool 
to  disinfect  wool  with  the  result  that  Bradford  and  other  wool  dis- 
tricts will  be  freed  from  the  menace  of  this  disease. 

Again,  in  another  instance,  it  was  found  that  when  the  wet 
bulh  thermometer,  liftiere  artificial  humidity  was  introduced  into  a 
cotton  mill,  rose  beyond  75°  Fahrenheit  the  body  temperatures  of  the 
weavers  themselves  began  to  rise  to  100°  or  101°,  and  this  was  the 
cause  of  their  complaint  and  objection  to  working  under  such  condi- 
tions. We  now  have  a  law  that  no  artificial  humidity  shall  be  intro- 
duced when  the  wet  bulb  thermometer  rises  above  75°  F.   I  am  perfectly 
certain  that  any  research  department  should  be  in  close  touch  with 
manufacturing  plants. 

I  do  not  think  the  field  of  the  industrial  physician  or 
surgeon  should  cover  that  of  the  safety  engineer  except  in  a  very 
general  way.  After  all,  the  doctor  cannot  be  expected  to  know  evei^- 
thing.   It  is  well  for  him  to  go  round  the  factory  and  make  sugges- 
tions as  to  whether  the  ventilation,  heating,  and  lighting  are,  in 
his  opinion,  good  or  bad,  but  he  may  blunder  badly  in  tryinp;  to  say 
how  the  remedy  should  be  applied.   That  is  what  the  factory  inspector 
should  be  trained  to  do.   In  Great  Britain  our  factory  inspectors 
are  drawn  largely  frcm  the  class  of  engineers.   Those  who  enter  quite 
eorly  in  life  prove  the  best.  We  have  chemists  who  are  also  valuable. 
In  Prussia  there  were  no  medical  inspectors  of  factories  up  to  the 
time  of  the  war.  Although  they  had  no  doctors  especially  associated 
with  factory  inspection,  and  Great  Britain  had  a  great  many,  we  had 


Dr.  Legge  -  Cont'd:  14, 

never  produced  a  book  on  the  subject.  However,  Germany  with  no 
factory  surgeons  has  produced  a  book  called,  "The  Factory  Surgeon". 

Should  there  be  special  training  provided  for  industrial 
nurses.   I  think  there  should  be. 

Should  field  investigations  and  special  studies  in  indus- 
trial plants  be  provided?  This  must,  of  course,  be  a  sine  qua  non. 

Should  there  be  provision  for  public  education  in  indus- 
trial hygiene  through  lectures,  literattire,  demonstrations,  visiting 
nurses,  etc.   This  should  be  provided. 

Should  effort  be  made  to  standardize  the  medical  equipment, 
quarters,  facilities,  etc.  in  industrial  plants?  There  should  be 
efforts  made  to  standardize  medical  equipment.  We  have  a  standard 
equipment  for  first  aid  and  ambulance  provision  in  Great  Britain  and 
in  the  course  of  a  year  or  two  we  shall  make  our  requirer.ients  applic- 
able to  practically  all  industries.  Briefly  it  is  this:   In  every 
engineering  shop  thers  muiit  be  provided  for  every  140  persons  a  first 
aid  box.   In  that  box  there  must  be  three  dozen  sterilized  finger 
dresainpjs,  one  dozen  sterilized  dre6sinp;s  for  the  hand  or  foot  and 
one  dozen  sterilized  dressings  for  other  parts  of  the  body.   There 
must  be  tincture  of  iodine,  sterilized  cotton  wool  and  eye  drors 
containing  0.5^  cocaine  in  castor  oil.  Where  there  are  more  than 
500  persons,  in  addition  to  this  first  aid  box  there  must  be  an  ambu- 
lance rocm,  because  our  feeling  is  that  a  workman  will  not  take  the 
trouble  to  walk  200  yards  to  be  treated.  Where  there  is  a  good  sur.bu- 
lance  room  sometimes  objection  is  rained  to  the  use  of  the  first,  aid 


Dr.  Legga  -  Cotxt'd:  16* 

box  in  addition,  VHiere  there  is  a  doctor  in  the  factory,  or  one 
visiting  there  every  day,  we  suppress  all  these  requirements. 

TThat  steps  should  be  taken  to  standardize  the  sanitary 
construction  of  factory  buildings  smd  appurtenances?  I  an  opposed 
to  the  standardizing  of  the  construction  of  factory  buildings.   Some 
parts  of  the  building  can  be  standardized,  but  whatever  you  do, 
leave  the  actual  construction  of  the  factory  buildings  to  develop 
as  the  architect  may  have  a  mind  to. 

Should  publications  be  issued  embodying  the  results  of  spe- 
cial pieces  of  roseerch,  standards  of  industrial  hygiene,  etc?  Nat- 
urally there  should  be  publications  embodying  the  results  of  research. 

I  give  you  what  in  my  opinion  should  be  the  function  of  the 
factory  physician: 

1.  Initial  detailed  medical  Axamination  of  all  applicants  for 

work,  attaching,  where  necessary,  conditional  certificates, 
either  on  personal  grounds,  or  as  to  the  nature  of  the 
work  on  which  he  or  she  is  to  be  employed. 

2.  Re-examination  of  such  persons  as  he  considers  need  it,  and 

power  of  inquiry  to  see  if  previous  conditional  certifi- 
cates have  been  observed . 

3.  Periodic  medical  examination,  under  regulations  and  special 

rules,  of  workers  in  special  dangerous  processes. 

4.  Periodic  medical  examination  of  those  who  have  suffered  from 

tuberculosis  and  of  all  others  (e.g.  those  with  heart 
disease,  disabled  soldiers,  etc.)  affected  with  illness 
which,  if  not  watched,  might  prove  incapacitating,  with 
power  to  specify  the  nature  of  the  work  upon  which  they 
may  be  employed. 

5.  Examination  of  ceses  referred  by  the  welfare  supervisor  and 

especially  to  advise  in  such  matters  as  outbreaks  of  occu- 
pational dermatitis  and  the  like,  for  which  treatment  oould 
be  prescribed. 

6.  Supervision  of  the  first  aid  and  ambulance  equipment  and  of 

its  use . 


Dr.  L«gg«  -  Cont'd:  18^ 

I  hope  that  in  Great  Britain  before  long  we  shall  have  part- 
time  state  medical  officers.  They  must  "be  linked  up  with  some  clinic 
where  they  can  have  the  assistance  of  experts,  one  of  whom  might  very 
well  have  studied  particularly  industrial  hygiene.  I  am  thoroughly 
opposed  to  a  state  medical  service  as  interfering  with  initiative  and 
reducing  the  level  of  efficiency,  but  I  am  just  as  strongly  in  favor 
of  a  part-time  state  medical  seirvice. 


17. 


Dr.  W,  Irving  Clark,  Jr, 

I  have  been  particularly  interested  in  what  Dr.  Legge  has 
had  to  say>because  it  so  absolutely  coincides  with  my  own  mental 
euiswers  to  these  questions .  He  has  come  to  the  same  conclusions 
that  I  have,  and  I  think  I  represent  the  men  who  are  doing  this  work. 
I  believe  if  people  working  along  the  same  lines  without  the  knowledge 
of  what  others  have  been  doing  reach  the  ssios  conclusions,  that  those 
conclusions  must  be  pretty  accurate. 

There  are  two  distinct  points  of  view  to  be  taken,  two  par- 
ties who  are  interested.   In  the  first  place,  the  practioa.1  nan  who 
is  doing  industrial  medicine;  in  the  second  plao6,  the  man  who  is  in- 
terested in  research  and  in  the  development  of  further  ideas  in  the 
study  of  conditions  of  the  men  who  are  being  tsiken  care  of  by  medical 
supervision.  My  experience  is  that  the  factory  is  willing  emd  able 
to  provide  funds  to  give  the  hospital  facilities,  but  are  not  able 
or  willing  to  provide  for  the  research  side  of  the  work.  That  is,  to 
my  mind,  a  thing  which  is  needed  very  muchfbecause  I  believe  that 
there  is  the  opening  wedge  in  that  idea.   If  we  can  once  get  industry 
as  a  whole  to  appreciate  the  possibilities  and  advantages  to  the 
country  and  their  own  industry  of  research  work  along  these  lines  it 
aearas  to  me  the  financial  backing  will  be  tremendous.  Manufacturers 
es  I  see  them  are  interested  definitely  in  the  medical  supervision  of 
their  employees.  When  I  began  ray  work  eight  years  ago  there  were  few 
companies  who  were  carrying  out  this  work,  but  it  has  Rreatly  in- 
creased until  now  there  is  hardly  a  very  large  corporation  which  is 
not  carirying  on  work  in  industrial  hygiene. 


Dr.  Clark  -  cont'd:  ,. 


As  far  as  research  work  goes,  there  is  no  definite  co- 
ordination between  the  teaching  in  medical  schools  and  the  actual 
work  in  factories.   I  think  this  is  cominj;.  As  far  as  the  actual 
work  goes,  the  type  of  man  who  is  doing  it  I  believe  should  be  of 
the  very  highest.  He  should  be  well  trained  and  should  have  taken 
some  intensive  work  in  industrial  hygiene.  This  is  necessary  be- 
cause the  avorag'e  man  does  not  get  that  type  of  training  in  the 
medical  school  or  in  the  hospital.   I  hope  to  see  the  very  best  men 
we  have  in  the  country  doing  industrial  hygiene. 

I  believe  in  part  time  work  because  I  believe  it  is  the 
greatest  advantage  to  the  industrial  man  to  keep  in  touch  with  scien- 
tific medicine  all  the  time.  He  should  be  engaged  in  practice,  not 
necessarily  private,  but  with  a  hospital.  The  combination  of  hos- 
pital with  industrial  practice  can  produce  more  efficient  work  than 
iny  other  combination  along  health  lines  that  I  know  of. 


19. 


Dr.  C.E.  Ford: 

I  think  I  agree  in  the  main  with  what  has  been  said.   I  per- 
haps disagree  with  Dr.  Clark  in  his  conunent  with  regard  to  part-time 
men.   I  thoroughly  believe  that  in  all  medico-social  service  whole-time 
men  are  preferable  to  part-time  men  because  the  latter  are  sure  to  let 
their  selfish  interest  interfere  with  their  work. 

The  great  problem  I  ajn  having  is  in  securing  medical  men  with 
a  social  conscience.  I  had  hoped  that  with  the  close  of  the  war  men 
would  be  available.  I  was  in  hopes  that  the  experience  of  men  in  army 
service  would  teach  men  to  work  with  groups,  to  work  with  an  organiza- 
tion.  Some  30  or  40  names  were  filed  in  my  office  during  the  year.  Ex- 
pecting this  fall  to  raorr^anize  my  staff,   I  salectad  the  best  ten  of 
that  group  and  corresponded  with  them.   I  asked  them  to  give  their  spe- 
cial reasons  for  wanting  to  enter  industrial  work.  That  particular 
question  was  nover  answered.   I  had  only  one  application  for  the  job. 
He  demanded  a  salary  of  |10,000  a  year.   I  will  concede  that  a  e;ood  in- 
dustrial surgeon  is  worth  that  sume  to  any  industrial  organization, be- 
cause I  think  the  industrial  surgeon  can  make  himself  just  as  valuable 
to  the  industry  as  the  superintendent  himself.  We  must  have  men  in 
industrial  medicine  who  have  had,  by  reason  of  wide  medical  experience, 
the  peculiar  requirements  incident  to  industry  and  contact  with  the 
public,  or  men  who  have  been  specially  trained  by  the  universities.  As 
yet  there  has  not  been  developed  the  facilities  for  so  doing. 

I  think  there  should  be  devised  some  manner  for  conducting 
research  Into  the  question  of  industrial  medicine. 


•  20. 


Dr.  Otto  p.  Geier: 

This  meeting  can  really  be  an  epoch  making  one,  depending 
upon  whether  this  conference  takes  a  sufficiently  wide  view  of  the 
problem  we  are  discussing.   If  we  take  the  broadest  view,  then  this 
meeting  may  make  a  real  contribution  to  world-wide  industrial  problems 
which  are  before  us  today. 

In  other  words,  are  we  talking  today  of  the  subject  of  indus- 
trial hygiene  or  are  we  talking  to  the  point  of  industrial  medicine 
in  its  broadest  aspect?  The  latter  term  is  far  more  inclusive.   Some 
of  you  may  take  exception  to  that  statement,  but  as  industrial  surgeons 
meet  today,  men  who  are  on  the  firing  line  giving  their  whole  thought, 
souls  and  bodies  to  this  subject  for  the  sake  of  the  industries  and 
for  the  sake  of  the  men,  they  include  something  far  greater  in  the  term 
"industrial  medicine"  than  industrial  hygiene  means  to  the  profession 
at  large. 

As  I  view  it,  this  group  today  is  discussing  what  possible 
contribution  industrial  medicins  may  make  towards  a  broader  and  more 
democratic  application  of  the  science  of  medicine  to  the  people  at 
large.   Dr.  Vincent  at  the  table  today  mentioned  the  diagram  which  I 
placed  before  another  meeting  here  yesterday.   This  diagram  emphasized 
the  necessity  of  realizing  that  the  practice  of  medicine  is  threatened 
with  certain  orgajiic  changes.   In  the  first  diagram  an  attempt  was  made 
to  portray  the  outstanding  features  of  medical  practice  as  they  obtain 
today.   It  purposes  to  show  how  inaooesslble  to  the  average  practi- 


Dr.  Q«ier  -  Cont'd:  21, 

tioner  and  to  the  average  patient  are  the  best  diagnostic  facilities 
and  treatment  that  the  profession  affords.   These  facilities,  pro- 
vided at  public  expense ,  should  not  be  accessible  to  the  rich  and 
the  poor  only*  Furthermore,  the  Chinese  Trail  between  the  leading  phy 
sicians,  the  hospital  group  and  teachers,  and  the  profession  at  large 
must  be  removed.  Efforts  must  be  made  to  democratize  knowledge  for 
the  benefit  of  better  medical  seirvice  to  the  great  producing  masses 
of  the  people.   The  present  scheme  makes  higher  standards  and  ade- 
quate medical  service  difficult. 

The  keynote  of  the  second  diagram  was  the  group  diagnostic 
clinic  just  in  the  infancy  of  its  development  in  this  country.  A 
system  of  early  diagnosis,  prevention,  and  cure  must  be  devised  to 
lower  the  sickness  rate  and  increase  production.   To  accomplish  this 
we  must  depart  from  our  intensely  individualistic  method  of  the  prac- 
tice of  medicine.   The  industrial  clinic  is  the  forervmner  of  some 
such  type  of  development  of  medicixte ,  looking  to  the  better  care  of 
the  worker.   The  industrial  olinic  acts  as  a  diagnostic  clearing  sta- 
tion for  the  producer  and  puts  him  directly  in  touch  with  the  best  in 
medicine. 

We  have  progressed  about  as  far  as  we  are  likely  to  progress 
in  the  matter  of  public  health  sujiervision.   The  public  is  8«turBt«»d 
with  the  material  it  gets  from  the  press.  We  must  find  some  way  of 
intensively  applying  our  knowledge  of  preventive  medicine.   If  we  can 
tie  up  a  nan's  work  with  his  health  prograjti,  he  will  accept  it. 

If  wc  stopped  all  research  today  and  did  nothing  but  apply 


Dr.  Oeier  -  Cont'd:  22, 

the  already  known  facts  for  the  next  ten  years,  the  general  level  of 
the  well-being  of  the  world  would  be  higher  than  if  we  put  so  much 
energy  into  research.  That  is  a  rather  drastic  method  of  bringing 
that  thought  to  you.   I  cannot  help  but  feel  that  medical  men  are 
stressing  too  much  the  need  for  further  extended  research,  and  are 
not  placing  before  these  foundations  the  tremendous  necessity  of  se- 
curing the  more  general  application  of  that  which  v/e  already  know. 

Dr,  Legge's  discussion  has  been  very  illiiminating,  and  I 
agree  with  most  that  he  has  said.  My  disagreement  is  with  the  posi- 
tion the  industrial  physician  should  hold.   If  we  are  to  make  this 
thing  work,  we  must  stop  thinking  in  terms  of  the  big  factory  and 
think  in  the  terns  of  the  factory  of  200,  300,  or  400  employees. 

When  we  are  doing  the  thing  vie   are  talking  about  today,  we 
open  the  first  way  toward  a  real  enlargement  of  medical  eund  health 
facilities  in  this  country.  Capital  must  pay  for  the  increased  health 
facilities  that  are  to  bo  brought  about.  V/e  know  that  it  is  diffi- 
cult to  get  enlarged  health  budgets.   On  the  other  hand,  when  industry 
spends  $8  to  |10  per   person  on  its  health  work,  it  gets  an  enlarged 
appreciation  of  public  health,  and  is  prepared  to  have  larger  funds 
spent  in  that  direction. 

Dr.  Legge: 
Have  you  in  America  anything  similar  to  our  panel  system  of 
oractice  in  Great  Britain,  where  each  individual  worker  chooses  his 
own  doctor? 


25, 


Dr.  Geier: 
The  only  parallel  that  we  have  in  that  direction  is  the 
Workroen's  Compensation  Acts,  whereby  workmen  are  compensA* ed  for 
loss  on  account  of  injuries  received  in  the  factories.  Possibly 
$100,000,000  are  beinp-  spent  in  this  country  annually  for  the  care 
of  injured  workmen.   In  Ohio  we  are  expending  some  $12,000,000  an- 
nually, of  which  $3,000,000  at  least  are  being:  wasted  because  indus- 
trial medicine  has  not  yet  sufficiently  been  advajiced  in  our  state. 


24. 


26, 


Dr.  Frederic  S.  Lee: 

We  have  been  speaking  of  imys  and  means  of  promoting  industrial 
hygiene,  of  conserving  the  health  of  the  industrial  worker,  but  what  is 
our  ultimate  object  in  doing  this?  The  ultimate  object,  it  seems  to  me, 
is  the  securing  of  maximum  production  without  impairing  working  power. 
With  this  object  in  view,  we  wish  to  discover  and  to  establish  the  con- 
ditions under  which  it  can  be  achieved,  under  which  the  worker  can  do  his 
host.  There  is  one  phase  of  this  general  subject,  a  phase  that  is  covered 
by  the  term  "industrial  physiology",  about  which  little  is  known  because 
it  is  very  new,  but  it  occupies,  I  believe,  a  position  of  foremost  import- 
ance, and  with  your  permission,  Mr.  Chairman,  I  propose  to  speak  briefly 
of  it. 

"indxistrial  Riysiology"  is  one  of  the  products  of  the  war.  Cer- 
tain premonitary  symptoms  of  its  coming  had,  however,  appeared  before  the 
war  began.   In  1913-14  some  of  the  leading  physiologists  of  France  formed 
a  plan  for  a  considerable  study  of  the  conditions  of  work  of  the  human 
mechanism  in  the  factory.   Their  intention  was  to  interest  their  own  and 
other  governments  and  undertake  an  extensive  international  iavestigation. 
The  coming  of  the  war,  however,  put  a  stop  to  their  designs.   But  the  war, 
curiously  enough,  afforded  in  other  countries  the  very  stimulus  that  was 
needed  for  the  inauguration  of  similar  plans-  and  the  result  has  been  that 
very  considerable  progress  has  been  made.  'Chn   first  move  was  made  by  the 
British  Health  of  Munition  Workers  Committee,  which  existed  from  1915  to 
1918.   The  Conraittee  issued  some  twenty-four  publications  on  a  variety  of 
topics,  the  papers  presenting  mainly  tho  results  of  original  investiga- 
tions and  terminating  wiih  the  very  important  final  report  on  "Tn.lustrial 


Dr.  L«e  -  Cont'd:  -  26. 

Health  and  Efficiency".   Similar  work  has  been  undertaken  by  the  Com- 
mittee's successor,  the  Industrial  Fatigue  Research  Board,  and  four 
additional  reports  have  already  appeared  under  its  own  name. 

In  1917  the  United  States  Public  Health  Service  became  in- 
terested in  the  subject,  and  conducted  similar  investigations  in  this 
country.   The  first  report  of  its  work  is  now  in  press,  while  other 
papers  are  in  preparation  for  early  publication. 

Canada  also  has  taken  up  the  work  and  has  very  recently  or- 
gemized  a  committee  for  carrying  on  similar  studies.   It  is  thus  seen 
that  this  subject  has  already  attracted  a  considerable  amount  of  atten- 
tion. 

Among  the  topics  which  industrial  physiology  has  so  far  con- 
sidered are  the  following: 

Industrial  fatigue 

Tests  for  fatigue 

The  relation  of  fatigue  and  ill  health  to  industrial 

efficiency. 
The  industrial  capacities  of  women. 
Hours  of  labor. 

Shifts,  breaks,  spells,  pauses  and  holidays. 
Svmday  labor. 
Night  wox'k. 
Lost  time 
Food 

Sickness  and  ill  health 
Injuries  and  accidents' 
Ventilation 
Heating  and  lighting 
Sanitary  conditions 
The  voluntary  limitation  of  output 
Labor  turnover 
Rhythm  in  industrial  operations 

All  these  subjects  eind  many  more  ccme  within  the  sphere  of  this  n*w 

science  of  industrial  physiology. 


Dr.  Lee  -  Cont'd:  2T 

There  are  two  things  that  are  greatly  needed  at  present  in 
this  matter: 

1   Investigation  ajid  the  encouragement  of  investigation.   It 
seena  to  me  that  the  opportunities  of  making  known  important  knowledge 
by  investigation  along  these  lines  are  boundless.   I  wish  that  you 
might  appreciate,  as  keenly  as  I,  what  seem  to  me  the  innvimerable  pos- 
sibilities in  the  way  of  improving  production  that  will  result  from 
this  kind  of  work.   Investigation  here  will  well  repay  encouragement 
and  assistance. 

2.  Education.  We  must  educate  investigators;  we  must  educate 
industrial  leaders;  we  must  educate  the  foremen  of  factories;  and  we 
must  educate  the  factory  workers.   I  am  interested  to  learn  that  the 
Canadian  Committee  proposes  to  organize  an  educational  campaign,  and 
proposes  also  to  urge  upon  Canadian  universities  the  importance  of 
introducing  courses  in  industrial  topics. 

Industrial  employers  are  already  taking  an  interest  in  this 
new  work.  It  is  very  signifioeoit  that  recently  two  of  the  leading  in- 
dustrial companies  in  this  country  have  appointed  physiologists  to 
positions  on  their  staffs.  The  Goodrich  Tire  Company  of  Akron,  Ohio, 
and  the  Scovill  Manufacturing  Company,  of  Waterbury,  Conn.,  have  each 
called  one  of  the  active  and  promising  younger  American  physiologists 
to  carry  on  work  of  this  nature. 

From  what  we  huve  already  learned  in  regard  to  the  value  of 
applying  the  principles  ot  industrial  physiology,  it  is,  I  think,  ob- 
vious that  if  the  work  of  the  factory  operative  is  to  be  performed 


Dr.  L8«  -  Cont'd:  ^^' 


most  effectively  it  must  be  organized  on  a  physiological  basis.  This 
promises  to  be  one  of  the  most  direct  and  most  fruitful  means  of  se- 
curing maziimim  production  and  maintaining  at  the  sajne  time  working 
power.   Industrial  physiologists  must  therefore  be  trained.   This 
should  be  planned  for  in  any  educational  scheme  that  may  be  devised 
for  the  development  of  industrial  h^iene. 


29. 


Mr.  C.-E.A.  Winslow: 

I  feel  that  aside  from  the  specialists,  the  actual  line 
worker  in  this  field  is  the  physician  uho  has  had  graduate  training 
in  industrial  hygiene.   There  is  no  necessity  for  a  special  degree. 
Many  of  the  institutions  ithich  are  interested  in  public  health  give 
a  certificate  in  public  health  for  one  year's  graduate  work  and  a 
Dr.P.H.  for  two  years'  work.  At  Yale  we  require  for  both  these  de- 
grees a  fundamental  course  in  public  health  including  sanitation,  the 
control  of  communicable  diseases,  the  organization  of  the  modern  pub- 
lic health  campaign,  and  the  like.  We  require  also  a  brief  course  in 
sanitary  engineering,  a  course  in  vital  statistics,  and  a  certain  a- 
jnovmt  of  public  health  bacteriology.   That  leaves  ample  time  for 
speoialiEing  in  industrial  hygiene  and  industrial  diseases.   The  man 
who  is  to  do  this  work  should,  in  my  judgment,  know  enough  sanitation 
to  be  able  to  judge  of  the  adequacy  of  ventilation  and  lighting  and 
to  say  what  is  wrong  and  to  lay  down  the  principles  upon  which  good 
ventilation  and  lighting  are  based. 

For  the  training  of  public  health  nurses  we  have  a  school 
for  public  health  nurses,  under  the  direction  of  the  V.N. A.  and  they 
get  brief  courses  in  industrial  hygiene  and  industrial  diseases  as 
part  of  their  eight  months   training.  We  have  only  made  a  beginning. 
In  an  adequate  department  there  ought  to  be  these  things  provided  for: 

1.  General  teaching  staff  interested  in  the  problem  of  indus- 

trial hyp;iene  in  all  its  aspects. 

2.  Occupational  clinic 

3.  Strong  supporting  courses  in  social  eoonomics  and  business 

4.  Provision  for  industrial  physiology 

5.  Definite  provision  for  sanitrvtion 

6.  Full  provision  for  research 

7.  Close  connection  with  industrial  plants. 


lir.  Winslow  -  Cont'd:  SOi 

In  an  institution  which  has  a  schcx)l  of  ^blic  health  organised  to 
give  grsiduate  work  in  the  general  field,  the  additional  things  that 
are  needed  to  do  this  work  should  not  be  very  difficult  to  secure. 

It  seems  to  me  we  need  in  this  field  a  number  of  centers. 
It  has  occurred  to  me  that  an  excellent  way  to  develop  this  sort  of 
beaching  throughout  the  country  would  be  to  take  institutions  in  a- 
bout  ten  centers,  and  say  to  the  manufacturers  of  the  locality,  "Are 
you  interested  in  this  thing",  if  so,  then  offer  |5,000.  or  $10,000 
to  be  matched  by  the  local  group  to  start  such  a  department.  As  soon 
as  it.  shows  itself  valuable  to  local  manufacturers  it  can  count  upon 
unlimited  support. 


SI. 


Dr.  W.  Gilman  Thompson t 

I  feel  that  Section  C  under  No.  2  is  out  of  place,  and  the 
question,  "Should  there  he  an  institute  of  hygiene"  should  head  the 
list  on  the  questionnaire.   There  is  going  to  be  an  institute  of  hy- 
giene in  this  country  sometime  very  soon,   i  should  not  be  surprised 
if  there  are  many  established  throughout  the  country.  We  are  dealing 
with  a  tremendous  economic  problem.   The  corporations  are  being  com- 
pelled by  law  to  take  better  care  of  their  workers.  There  is  no  one 
existing  place  in  the  country  which  could  supply  all  the  features  of 
such  an  institution  as  has  been  suggested  here.  The  whole  question 
is  this:  Are  we  to  have  somewhere  in  this  coiintry  a  focus  to  study 
this  entire  field,  where  all  the  known  faots  are  to  be  collected, 
studied  and  properly  arranged,  where  instruction  can  be  given  to  phy- 
sicians and  nurses,  and  through  the  institution,  to  the  workmen  ajid 
the  general  publio.   There  is  excellent  opportunity  for  some  founda- 
tion, individuals  or  group  of  corporations  to  see  that  an  institution 
be  established  which  will  set  up  educational  standards  which  other 
Institutions  feel  they  will  have  to  approach.  My  conception  of  the  or- 
ganization of  an  institute  of  industrial  hygiene  is  shown  by  this 
general  plan:      (Qraph  follows  on  page  52) 

Should  there  be  a  separate  institute  of  industrial  hygiene? 
I  take  that  to  mean  an  institute  not  connected  with  a  medical  college. 
A  general  affiliation  is  very  desirable  for  economic  reasons,  and  for 
other  reasons.   Many  of  the  professors  can  be  drawn  rrom  a  university 
bat  not  from  a  medical  college. 


32. 


Board 

I 
Director 

and 
Assist  ant^ 


Medicine 
(Special 
Diseases  ) 

Svirgery 

( Bluer  gen- 
cies.  etc^^ 

Architecture 

and 
Engineer  iiu! 

pCnsuranoe 
Laws,  etc) 

Statistics 

and 
Progress 

Riysiology 

Pathology 

Clinical 
Pa.thology 

Working  Conditions 
Hygiene  of  Plants 
Accident  PreirentiaE 

Types  of 
Industries 
and  Disease 
Hazards 

Training 

of 
Nurses 

Reports  and 

Education 

Education 

lAspeotions 

of  the 

of  the 

for 

Workman 

Public 

Qnployers 

The  Hospital  -with  Out-Rj-tient  Clinic 
is  for  study  of  industrial  accidents 
and  diseases,  their  pathology  and 
methods  of  physiotherapy. 


GENERAL  PLAN  FOR  AN 
INDUSTRIAL  HTGIENE  INSTITUTE 
W.  Oilman  Thompson 


Dr.  Thompson  -  Cont'd:  38* 

Some  time  ago  I  was  asked  to  organize  the  medical  service 
of  one  of  the  large  corporations,  and  our  experience  has  been  abso- 
lutely against  the  part-time  doctor.   They  do  not  serve  the  company  as 
they  should.   I  do  not  mean  you  should  not  have  the  part-time  doctor, 
but  you  need  men  at  the  head  of  the  service  who  give  all  their  time . 
The  head  of  the  orgamization  should  unquestionably  be  a  full-time  man 
and  well  paid. 

I  should  like  to  refer  to  the  surgical  aspect  of  the  situa- 
tion; we  have  thus  far  emphasized  only  medicine .   Industrial  surgery 
has  become  as  important  in  industrial  work  as  medicine.   If  there  has 
been  one  thing  which  more  than  smother  has  impressed  me  it  is  the  very 
large  nviraber  of  industrial  accidents  which  result  in  disability,  which 
without  very  special  technical  care,  is  liable  to  become  pernianent.   I 
merely  wish  to  emphasize  the  importeince  of  introducing  into  any  plan 
to  broaden  the  teaching  of  industrial  medicine,  the  teaching  of  indus- 
trial surgery  by  the  modem  methods  which  have  received  such  an  impetus 
during  the  war. 

I  would  like  to  emphasize  onoe  more  the  training  of  the  indus- 
trial nurse.   To  my  mind  she  is  just  as  important  In  tne  well  organized 
industrial  plant  as  the  physician. 

Now  let  us  discuss  more  in  detail  the  advantages  of  a 
central  focus  for  industrial  hygiene  education  as  compared  with  a 
series  of  smaller,  scattered  institutions. 

1.   The  strongest  arg>»ment  for  such  a  center  is  found  in  this 
conference  itself  at  which  the  diversity  of  views  and  interests  deaon- 


Dr.  Thompson  -  Cont'd:  S4, 

etrate  strikingly  the  need  for  a  central  clearing;  house,  a  place  for 
establishing  educational  standards,  as  well  as  for  the  stimulation  of 
research. 

2.  Many  years  would  be  required  to  develop  the  beat  type  of  per- 
sonnel in  a  dozen  different  institutions,  whereas  the  central  institu- 
tion would  largely  be  occupied  in  training  personnel  to  serve  smaller 
institutions  in  various  parts  of  the  country.  A  large  enough,  first- 
class,  trained  personnel  to  supply  an  extensive  group  of  small  institu- 
tions is  not  yet  existent. 

3.  A  single  parent  institution  could  promptly  be  established  and 
begin  to  functionate  much  sooner  than  a  dozen  smaller,  scattered  insti- 
tutions could  be  developed. 

4.  It  would  enable  the  carrying  out  of  expensive  laboratory  re- 
search, which  could  not,  in  many  instances,  be  financed  economically 
in  smaller  institutions. 

5.  It  would  emphasize  in  the  minds  of  industrial  corporations 
the  fact  that  industrial  medicine  and  surgery  are  distinctly  special- 
ized, and  it  would  do  more  than  anything  else  to  stimulate  these 
corporations  to  greater  efficiency  in  the  hygienic  care  of  their  em- 
ployees. 

6.  It  would  enable  the  testing  of  experiments  and  methods,  which, 
until  their  value  is  proven,  might  better  and  much  more  economically  be 
conducted  in  one  central  institution. 

7.  It  Would  enable  the  concentration  of  a  oolleotion  of  Industrial 


Dr.  Thompson  -  Cont'd: 

50« 


Hygiene  data  of  all  kinds,  and  serve  as  a  reference  board  for  Indus- 
trial Hygiene  problems  which  might  arise  in  any  part  of  the  country, 
being  entirely  free  from  local  jealousies  or  xmfavorable  influences. 

8.  Far  from  retarding  the  growth  of  smaller  institutions,  frcm 
its  very  "non -partisan"  character,  it  forthwith  would  establish  a  goal 
of  efficiency  to  which  they  might  all  seek  to  attain. 

9.  A  large  fund,  divided  among  many  small  institutions  instead 
of  being  applied  to  one  greater  center,  would  encounter  many  diffi- 
culties in  existing  organization.  That  is,  one  institution  would  wish 
to  develop  industrial  hygiene  under  its  public  health  school,  another 
under  its  medical  school,  another  in  connection  with  a  hospital, 
another  without  a  hospital,  etc.,  so  that  varying  emphasis  would  always 
be  given  to  the  work.  The  time  is  soon  coming  when  no  first-class  medi- 
cal ■ehool  can  longer  afford  completely  to  ignore  Industrial  hygiene 

in  its  curriculum,  and  that  in  itself  is  a  further  argument  for  a  cen- 
tral organisation  to  which  all  others  may  look  for  ideal  standards  to 
be  approached  as  nearly  as  local  conditions  admit. 

What  are  the  arguments  for  a  hospital  and  out-patient  service 
in  connection  with  a  central  industrial  hygiene  institute? 

1.  The  hospital  is  needed  to  enable  the  collection  of  industrial 
diseases  and  accident  cases  for  group  study  and  intensive  research. 

2.  It  is  ne'^ded  to  establish  said  demonstrate  the  modern,  very 
specialised  methods  of  treatment  of  these  oases.  Especially  is  this 
true  of  all  the  elaborate  apparatus  ax>d  methods  of  treatment  for  physio- 


Dr.  Thompson  -  Cont'd:  35^ 

therapy,  (hydro, electro,thermo-therapy,  massage  emd  physical  exercises) 
demonstrated  through  war-time  experiences  as  invaluable  in  shortening 
the  period  of  disability  after  injuries. 

3.  The  out-patient  clinic  is  needed  to  enlarge  the  experience  of 
the  physician  in  the  great  variety  of  industrial  diseases  and  injuries. 

4.  Such  a  clinic  constitutes  the  hximan  laboratory  for  research, 
and  is  just  as  important  for  the  school  as  its  chemical  and  physiologi- 
cal laboratories,  designed  for  prosecution  of  material  research. 

5.  One  might  as  well  attempt  to  treat  an  obstetric  case  in  a  gen- 
eral hospital  ward  among  other  patients  as  bo  deal  in  that  manner  with 
many  of  the  industrial  ca^es.  Nurses,  attendants  emd  physicians,  all 
alike,  need  concentrated  training  in  the  advanced  methods  of  dealing 
with  industrial  cases. 

6.  The  industrial  accident  oase,  like  the  wounded  soldier,  needs 
a  special  environment  and  atmosphere,  as  much  for  the  psychic  as  the 
essential  physical  part  of  his  treatment,  attained  in  part  through  occu- 
pational-therapy as  very  technically  adapted  to  his  injuries.   The  in- 
dustrial physician  and  nurse,  to  be  of  the  highest  value,  should  have 
opportunity  for  training  in  all  these  methods,  in  wards  and  out-patient 
classes  segregated  frcsn  the  very  different  methods  required  for  ordinary 
hospital  cases,  like  those  of  pneumonia  and  appendicitis. 

7.  The  ordinary  general  hospital  seirvice,  so  long  adapted  to  other 
more  or  less  routine  methods,  cannot  include  industrial,  medical,  or 
surgical  cases  without  detriment  to  both  services. 


87. 


Dr.  J.W.  Sohereechefwsky: 

This  institute  is  clearly  a  function  for  the  federal  gov- 
ernment , because  it  is  something  to  be  done  for  the  nation  as  a  iihole. 
Some  such  institution  as  that  should  be  financed  and  supported  by 
the  national  government.   The  functions  which  Dr.  Thompson  has  illus- 
trated are  essentially  the  duties  of  the  government,  which  are  ad- 
visory, investigative  and  oo-operat5ve.  As  a  general  government 
principle  I  feel  that  activities  of  this  kind  are  primarily  the  func- 
tions of  the  government  to  carry  on.   It  is  a  duty  which  it  owes  its 
citizens  and  should  not  be  carried  on  by  private  enterprises .   It 
should  come  under  the  federal  seirvice. 

Dr.  Otto  P.  Geier: 
If  the  government  had  $300,000  to  spend  on  this  sort  of  in- 
stitution would  it  not  be  better  to  subsidize  ten  institutions  rather 
than  try  to  set  up  one  station. 

Dr.  J.  W.  Soheresohewsky: 
Yes .  As  to  the  kind  of  institution,  the  sort  of  work  which 
Dr.  Thompson  wishes  to  have  carried  out  is  primarily  a  work  for  a 
governmental  agency. 

Ibr.  Oeorge  B.  Vincent : 
How  could  the  plan  be  furthered  as  a  government  plan? 

Dr.  J.  W.  Soheresohewsky I 
Have  a  bill  introduced  into  Congress  to  further  the  study 
of  industrial  hygiene  and  have  manufacturers  make  it  clear  to  Congress 


Dr.  SchereschewBky  -  Cont'd:  '^ 


that  it  is  a  needed  activity;   provide  agencies  for  creating  public 
sentiment.  I  think  one  of  the  most  encouraging  things  we  have  now 
Is  the  oo-operation  between  the  Public  Health  Service  and  the  Inter- 
national Health  Board  in  attacking  the  malaria  problem. 


89. 


Dr.  Reynold  A.  Spaeth: 

The  Department  of  Physiology  of  the  School  of  Hygiene  and 
Public  Health  in  Baltimore  is  developing  in  its  work  along  the  lines 
relating  directly  to  the  field  of  industrial  hygiene.   I  voice  the 
feeling  of  Dr.  Welch  and  some  of  the  other  members  of  the  faculty  irhen 
I  say  that  a  Department  of  Industrial  Hygiene  could  most  efficiently 
be  developed  in  connection  with  a  school  of  public  health.  A  separate 
institute  is  not  particularly  desirable  or  necessary.  We  feel  that 
industrial  hygiene  involves  the  general  principles  of  hygiene  and  pub- 
lic health  as  applied  to  industry. 

Costly  duplication  of  equipment  would  be  necessitated  by  a 
separate  institute,  and  furthermore  there  is  no  single  research  labora- 
tory for  industrial  hygiene.   In  connection  with  a  school  of  public 
health  ample  laboratory  facilities  would  be  provided  for  the  investiga- 
tion of  special  problems. 

I  am  not  in  position  to  add  ainything  to  what  has  been  said 
concerning  the  purely  medical  phases  of  industrial  hygiene.   I  might 
suggest  one  thing.   I  believe  it  is  important  to  bear  in  mind  that  a 
division  of  "clinical  psychology"  (Psychiatry)  should  be  established, 
a  division  *hich  would  include  the  study  of  various  industrial  psychoses 
and  neuroses,  etc.   The  questions  of  illumination  and  ventilation  are 
too  much  taken  up  by  men  who  have  had  purely  engineering  training.   The 
physiological  aspects  of  both  subjects  are  neglected.   I  should  like  to 
see  a  Department  of  Industrial  Hygiene  include  the  general  subject  of 
industrial  psychology.   Under  this  head  we  have  a  great  deal  of  material 


Dr.  Sp»eth  -  Cont'd:  40. 

thPt  oueht  to  be  given  serious  consideration.   I  have  in  mind  the 
theory  and  practice  of  trade  and  intelligence  tests.  Other  questions 
such  as  the  psychological  standardization  of  workers,  the  organization 
and  function  of  employment  management,  the  question  of  the  theory  of 
wage  payments  and  incentives;  the  creative  impulse,  the  theory  and  prac- 
tice of  the  acquisition  of  skill  and  the  training  of  apprentices  would 
all  legitimately  fall  under  the  caption  of  industrial  psychology- 
There  are  a  number  of  subjects  which  may  conveniently  be  in- 
cluded under  the  general  caption  of  "welfare"  or  social  service  work 
which  are  at  present  too  frequently  in  the  hajids  of  highly  enthusias- 
tic but  untrained  and  sentimental  amateurs.  A  department  of  industrial 
hygiene  should  provide  for  the  adequate  scientific  training  of  these 
workers  in  so  far  as  their  work  has  a  scientific  basis.   For  conven- 
ience in  orgemization  such  subjects  as  workmen's  compensation  insurance, 
factory  and  labor  legislation,  organized  recreation,  co-operative  stores, 
rest  and  reading  rooraB,  adequate  and  nutritious  food  dispensed  in  proper - 
Iv  eauipperi  cafeteria;  housing  and  the  standardization  of  factory  con- 
struction could  all  be  included  under  a  division  of  industrial  sociology. 

Provision  should  be  made  for  an  industrial  consulting  service, 
which  would  correspond  to  No.  3  of  Dr.  Thompson's  chart.   I  have  in  mind 
an  orgemization  which  would  permit  the  department  to  get  into  contact 
with  industries.   It  seems  to  me  it  is  important  to  get  into  contact 
both  with  organized  management  and  with  organized  labor.  We  should  get 
in  touch  with  the  chambers  of  oorunerce  and  manufacturers '  associations 
in  our  own  and  other  cities  and  have  the  nen  in  the  school  represented 


Dr.  Spaeth  -  Cont'd:  ^^^ 

on  the  program  of  meetings  which  emphasize  the  production  side.   It 
would  be  highly  desirable  to  publish  readable  accounts  of  the  work  and 
aims  of  the  work  in  such  aagazines  as  Industrial  Management,  System, 
and  Factory. 

The  general  objective  of  such  a  department  would  be  the  in- 
struction of  industrial  physicians;  the  instruction  of  a  second  group 
whom  we  might  call  industrial  consultants;  industrial  nurses  and  soc- 
ial service  workers.  Research  work  would  be  carried  out  in  the  labor- 
atories of  the  school  and  industrial  field  data  could  be  worked  up  in 
the  Department  of  Vital  Statistics. 

■flie  remarks  I  have  made  are  in  no  sense  to  be  considered  the 
official  opinion  of  the  faculty  of  the  School  of  Hygiene  but  are  large- 
ly my  personal  impressions  of  the  organization  and  objectives  of  a  De- 
partment of  Industrial  Hygiene  in  a  School  of  P\xblic  Health. 


42. 


Dr.  Eniery  R.  Hayhurst : 

There  are  two  or  three  things  that  have  not  been  touched 
upon  perhaps  at  all,  and  then  some  not  sufficiently  enough.   One  ques- 
tion is.  What  is  the  relation  between  industrial  hygiene  and  public 
health  work  as  regards  the  number  of  personnel?   In  Ohio  we  beliave 
that  102  places  filled,  and  about  50  more  to  be  filled,  would  handle 
the  health  machinery  of  the  state.   If  we  attempted  to  do  that  for 
industry  160  would  not  be  enough.   This  branch  of  public  health  work 
requires  a  much  greater  personnel  than  does  that  of  public  health 
work,  -  many  industrial  physicians,  etc.  in  a  single  city.   Therefore 
should  it  not  be  a  field  of  its  own?  \7hat  is  wanted  is  physicians 
specially  trained;  that  has  already  been  gone  over. 

About  one  year's  training  of  a  recent  graduate  physician  is 
about  what  is  wanted  to  prepare  him  for  a  good  industrial  physician 
and  surgeon,  especially  with  the  point  of  view  he  should  have.  He 
should  got  in  that  training  that  which  would  make  him  a  good  public 
health  officer  also.   If  he  wishes,  in  the  course  of  that  training, 
to  raaJce  his  work  a  specialty  in  industrial  hygiene,  he  can  announce 
his  thesis  subject  in  December  of  the  first  semester.   That  is  the 
plan  we  are  following  in  Ohio  in  our  course  for  preparing  health  offi- 
cers.  Our  course  is  as  follows: 

First  Semester  Second  Someater 

Hygiene  -  Personal  Preventive  Medicine 

Publir;  Health  Administration  and  Hygiene  -  Industrial 

Public  Health  Problems  Social  Service  and  Pub. Hlth. Nursing 

Vital  and  Sanitary  Statistics  Conmunicable  Diseases 

Communicable  Diseases  Public  Health  Knp-.ineering 

Public  Health  Engineering  Seminar  and  Thesis 

Public  Health  Laboratory  and  Public  Health  Laboratory  and 

Inspection  Methods  Inspection  Methods 


Dr.  Hayhurst  -  Cont'd:  4^ 

This  course  leads  to  a  Master's  decree  in  scionca. 

Dr.  Selby  went  throuf;h  about  170  industrial  plants  in  the 
middle  and  eastern  states  and  he  found  this:   In  42^  the  industrial 
medical  serrice  was  under  the  department  of  production;  in  21?J  it  was 
under  the  department  of  compensation;  in  18^  it  was  answerable  to  the 
administrative  head;  in  15??  it  was  answerable  to  the  employnent  de- 
partment. He  came  to  the  conclusion  that  the  place  for  this  was  under 
the  direct  administrative  head.   The  correct  relation  of  the  medical 
eenrice  is  one  thint;  which  should  be  stabilized  early.   It  will  not 
have  much  influence  in  an  industry  if  industrial  medicine  is  made  an- 
swerable to  a  minor  department  of  the  organization.  The   man  who  repre- 
sents this  work  should  have  equal  standing  with  the  company's  attorney 
and  should  attend  the  directors'  meetings:   he  has  a  maior  responsi- 
bility in  stabilizing  labor  relations. 

Another  feature  that  is  lacking  is  the  absence  of  "Ret-to- 
gether" in  the  plants  themselves,   lack  of  co-operation  between  the 
plant-nanager  and  his  engineer,  chemist,  employment  agent  and  medical 
director.  Again,  the  scope  of  the  medical  director  who  must  be  trained 
in  the  principle  of  hygiene  and  preventive  medicine,  must  be  enlarged. 
An  arrangement  for  teaching  between  the  plant  and  the  college  would  go 
a  long  way  toward  remedying  that.  We  have  instances  in  wnion  our 
senior  students  are  employed  by  plants  overnight  to  do  first-aid,  and 
that  gives  them  some  insight  as  to  what  are  the  industrial  needs  of 
physicians,  but  tney  should  get  some  undergrauluate  training  in  indus- 


Dr.  Bayhorat  -  Cont'd:  44. 

trial  hygiene  as  well. 

As  to  whether  there  should  be  one  central  institute  of  in- 
dustrial medicine,  or  several  scattered  over  the  country,  it  would 
appear  to  me  that  one  institute  might  satisfy  a  locality,  but  it 
would  have  to  have  branches  to  cover  satisfactorily  the  whole  country. 


4S. 


Dr.  Cecil  K.  Drinker; 

I  have  been  extremely  interested  in  the  statements  of  Dr. 
Howe .because  if  one  attempts  to  size  up  the  character  of  the  teach- 
ing nhich  should  be  given  in  such  an  organization  as  we  have  formed 
in  Boston,  he  is  led  to  a  conviction  that  one  of  the  things  most 
seriously  needed  is  instruction  in  the  art  of  developing  and  dissemi- 
nating industrial  health  propagsinda. 

It  has  been  my  duty  in  connection  with  the  industrial  health 
work  at  Ife.rvard  to  deal  with  the  students  and  with  certain  of  the  in- 
vestigations which  have  been  undertaken.   I  can,  therefore,  give  you 
some  practical  information  which  may  be  of  interest. 

In  the  first  place,  in  regard  to  research:   During  the  year 
and  three-quarters  in  which  the  Harvard  work  has  existed,  a  number  of 
problems  have  been  submitted  to  us.  About  one  year  ago  Dr.  Edsall  and 
I  undertook  an  investigation  in  regard  to  poisoning  by  manganese  which 
was  brought  to  us  by  a  large  company  with  headquarters  in  New  York. 
Investigation  of  this  situation  demanded,  in  the  first  place,  high- 
grade  clinical  emd  neurological  work,  and  secondly,  laboratory  work 
which  required  the  services  of  a  mechanical  engineer,  a  physical  chem- 
ist, and  a  physiologist,  together  with  several  teohnicians. 

During  the  war  we  had  several  assignments  for  investigation 
in  connection  with  TNT  poisoning.   To  answer  these  calls,  careful 
clinical  examination  of  a  group  of  individuals  was  needed  together 
with  expert  opinion  upon  blood  pathology. 


Dr.  DrinJcer  -  Cont'd: 


46. 


Recently  we  have  been  asked  to  give  information  to  a  large 
concern  as  to  the  possible  harmful  effects  of  an  organic  dust.   This 
investigation  requires  the  services  of  a  clinical  and  X-ray  man,  a 
nose  and  throat  man,  a  man  trained  in  the  problems  of  engineering 
and  ventilation,  and  a  man  qualified  to  determine  the  bacterial  con- 
tent of  the  dust. 

A  request  has  just  come  to  us  to  give  advice  and  help  in 
connection  with  a  plant  using  tetrachl or ethane.  Here,  the  services 
of  an  extremely  well-trained  chemist  are  necessary. 

One  year  ago  we  were  approached  by  a  group  of  men  from  the 
large  department  stores  in  Boston.   These  men  came  to  us  and  said, 
"W©  employ  doctors,  nurses  and  welfare  workers.  Why  don't  you  in- 
clude us  in  your  teaching  program?"  Finally  we  have  agreed  to  do  so, 
and  have  entered  into  a  complete  study  of  the  whole  subject  of  health 
in  mercantile  establishments.  We  are  now  the  accents,  in  this  investi- 
gation, of  twenty  or  more  stores,  and  shall  spend  the  next  five  years 
investigating,  reporting  and  recommending. 

In  addition  to  these  requests  which  we  have  met,  we  have 
been  asked  to  consult  in  a  large  spinning  and  weaving  establishment 
in  regard  to  fatigue,  to  establish  in  Tennessee  a  health  department 
for  a  small  town  built  about  a  large  spinning  industry.  Our  failure 
to  answer  these  last  calls  has  not  been  from  einy  lack  of  interest  in 
thora,  but  from  inability  to  carry  the  personnel  necessary  to  spread 
through  so  many  fields. 

The  instances  which  I  have  cited  are  ample  to  snow  that  in- 


Dr*  Drinker  -  Cont'd:  47, 

dustrial  health  work  cannot  be  carried  on  by  a  small  organization. 
Extended  facilities  are  required,  and  such  sums  as  $25,000  a  year 
will  not  meet  the  needs  of  the  situation,   I  believe  it  is  necessary 
to  use  great  judgment  in  the  research  calls  which  any  such  organiza- 
tion answers.  One  should  be  certain  that  he  can  perform  real  ser- 
vice before  going  into  a  factory.   If  this  is  not  done,  industry  will 
cultivatft  a  distrust  of  scientific  medicine  whi'jh  will  eventually  do 
great  harm. 

Finally,  in  regard  to  the  direct  needs  which  we  have  ex- 
perienced in  Boston,  I  should  say  that  they  are  confined  to  the  or- 
ganization of  a  thoroughly  good  chemical  department  and  to  the  estab- 
lishment of  a  department  devoted  to  education  in  health  matters .  We 
have  already,  through  Simmons  College  and  the  School  of  Social  Ser- 
vice in  Boston,  made  affiliations  which  should  begin  to  cope  with  the 
questions  of  industrial  nursing  and  welfare  education. 

A  few  words  relative  to  the  type  of  students  coming  to  us. 
If  you  rely  upon  post-graduate  material  for  a  School  of  Industrial 
Hygiene,  you  deal  with  a  dismal  group  of  students.   During  the  past 
Bummor  I  have  spent  a  largo  amount  of  time  interviewing  men  who  wish 
to  enter  Industrial  Hygiene.  A  very  large  proportion  of  these  were 
obviously  failures  in  general  practice.   Something  must  be  done  to 
bring  this  field  to  the  attention  of  the  best  type  of  undergraduates. 
The  questions  of  research  and  supply  of  men  for  factory  work  will 
take  care  of  themsolvos  if  we  can  get  the  best  type  of  younf,  men 
interested. 


48. 


Mr.  Charles  Baskerville: 

The  universal  publicity  given  to  the  use  of  "poison  gas"  in 
the  World  War  tindoubtedly  directed  greater  attention  in  the  United 
States  to  chemistry,  with  its  mysterious  possibilities,  and  the  chemi- 
cal industry,  with  its  opportunities  for  production  of  wealth  and 
possible  control  of  trade  therewith,  than  any  other  agency  in  modern 
time.   Germany's  specialization  in  the  manufacture  of  coal  tar  deriva- 
tives coupled  with  extensive  propaganda  created  an  erroneous  impression 
of  the  non-existence  of  a  pre-war  chemical  industry  in  the  United  States. 
In  this  country  no  necessity  exists  to  contradict  the  false  impression, 
but  it  is  a  fact  that  the  war  brought  about  a  remarkable  stimulation  to 
Amerioan  chemical  industry. 

The  pressure  drove  existent  plants  to  intense  systems  for 
super-production.  The  exigency  of  the  emergency  brought  about  the  hasty 
construction  of  many  plants  for  the  production  of  chemicals  of  great 
variety  needed  in  the  prosecution  of  the  war.  The  speed  factor  did  not 
admit  providing  all  the  preventives  for  the  protection  of  the  workers  in 
some  instances,  and  the  trans ientness  of  contracts  in  others  caused  little 
concern  for  the  welfare  of  labor.  Chemicals  have  received  and  are  to  re- 
ceive most  of  the  blame.   Unusual  attention  has  thus  become  directed  to 
industrial  hygiene,  which  means  "chemicals". 

These  and  other  factors  associated  with  the  enormous  and  perm- 
anent development  of  the  chemical  industry  have  caused  thinking  chem- 
ists to  give  the  subject  most  serious  consideration,  oft  expressing  a 
strong  hope  that  something  worth  while  might  be  done  in  a  large  con- 
structive way  to  better  the  conditions  of  the  labor  of  the  industry. 


Mr.  Baskerville  -  Cont'd  49. 

Something  has  been  dona  by  individual  corporations.  Public 
Health  (National,  State  and  Municipal)  Boeirds,  and  Social  Welfare  and 
other  organizations,  but  it  has  not  been  co-ordinated.   Prior  to  the 
war  the  American  Chemical  Society,  through  initiation  by  the  Now  York 
Section,  organized  a  conmittee  on  Occupational  Diseases  in  the  Chemical 
Trades.   The  speaker  has  been  Chairman  of  this  Coinnittee  since  its  form- 
ation and  has  attended  niamerous  meetings  seeking  to  do  something  of 
value,  primarily  through  developing  the  interest  of  the  manufacturers, 
co-operation  on  obtaining  unifonn  legislation  in  the  different  states 
and  mtuiicipalities  and  bringing  about  a  limited  degree  of  publicity  main- 
ly among  chemists.  Something  has  been  done  in  the  way  of  research,  in 
legislation,  and  in  publicity. 

In  the  first  we  have  stimulated  various  health  agencies  to 
study  conditions  in  the  main  and  co-operated  with  representatives  of 
Boards  of  Health  and  Bureaus  of  Labor  in  their  investigations. 

In  the  second  we  have  co-operated  in  formulating  some  uniform 
laws  for  a  number  of  states  and  cities,  especially  in  the  connection 
with  wood  (or  methyl)  alcohol. 

In  the  third  we  have  secured  important  contributions  from 
specialists  and  caused  them  to  have  wide  distribution  in  the  trade. 

The  work  has  not  been  systematic  or  organized,  for  the  very 
good  reason  that  it  has  had  no  financial  support.   The  Committee  feels, 
while  it  may  secure  contributions  for  its  work,  that  now  is  the  time 
when  the  work  should  be  undertaken  according  to  a  large  program,  which 
would  call  for  more  money  than  it  could  hope  to  secure.   Furthermore 
the  program  would  call  for  the  co-oporation  of  the  chemist  and  not  his 
direction.   It  calls  for  special  training  in  the  field  of  preventive 


Mr.  Baskerville  -  Cont'd  60. 

medicine,  which  involves  social  welfare. 

The  mephitic  odor  of  the  laboratory  covers  a  maze  of  mystery 
in  the  lay  mind  and  is  held  responsible  for  niomeroua  maladies.   The 
word  "chemical"  is  sinister.  Where  chemical  processes  are  in  operation, 
especially  when  fvimes  or  vapors,  even  though  the  latter  be  only  steam, 
are  seen  to  escape  from  the  works  there  grows  a  feeling  of  suspicion, 
often  with  reason,  and  all  kinds  of  sickness  are  attributed  to  these 
"poisonous  substances."   If  the  speaker  may  judge  from  numerous  letters 
even  the  meir.bers  of  the  medical  profession  are  not  free  from  these  sen- 
sations and  confessions.  And  well  they  may  be  in  many  instances,  for 
even  though  the  action  of  many  chemicals  in  varying  degress  of  concen- 
tration be  known,  the  insidious  effects  of  many  more  are  absolutely 
closed  books.   They  require  most  diligent  study  and  painstaking  re- 
search. 

In  this  connection,  there  is  an  urgent  need  for  publication 
of  an  immense  amount  of  valuable  research  carried  on  by  the  Chemical 
Warfare  Service  of  the  Anny  and  Navy,  which  now  appears  to  have  little 
chance  to  reach  the  light  of  day.   The  data  on  the  physiological  factors 
and  changes  involved  in  fatigue  are  of  imnenee  value.  The  alterations 
in  gas  masks  for  use  in  chemical  industries  in  peace  times  constitute 
an  important  problem.   The  fact  that  workers  (soldiers  and  civilians) 
in  chlorine  plants,  or  where  small  amounts  of  ohlorine  permeate  the  air, 
were  practically  immune  to  influenra  during  the  first  epidemic  while 
their  neighbors  living  and  working  under  similar  conditions,  save  the 
ohlorine,  were  stricken  right  and  left,  opens  a  vista  comparable  to  the 
hopeful  days  of  the  Pneumatic  Institute,  out  of  whloh  came  Inhalation 


Mr.  Baskerville  -  Cont'd  ^^» 

anesthesia,  gasecus  diainfection,  and  foundational  knowledge  of 
bacterial  chancres. 

There  are  good  people  in  the  chemical  industries  and  there 
are  farsighted  corporations  seeking  means  to  improve  conditions,  but 
the  evils  of  the  conditions  first  serve  to  call  attention  to  their 
existence.  Efforts  to  palliate  are  evident  in  providing  medical  at- 
tention*  It  is  good  business  to  have  healthy  labor,  but  the  motive  is 
primarily  humanitariein.  Multiplication  and  adaptation  of  education  for 
the  workers  call  for  teachers  with  qualifications  peculiar  to  the  needs. 

The  excellent,  but  limited  programs  of  training  given  at  a 
few  institutions  have  been  spread  before  us,  but  we  have  also  heard  it 
stated  here  that  suitably  trained  men  and  women  oeinnot  be  had  in  ade- 
quate numbers  to  meet  the  demand* 

I  speak  without  authority,  but  I  assert  with  assurance  that 
the  chemical  industry  will  welcome  and  co-operate  with  the  separated 
efforts  for  the  improvement  of  conditions.   But  it  will  go  much  further 
if  those  efforts  be  co-ordinated.   So  I  venture  to  say  that  it  would 
appear  desirable  to  extend  the  present  localited  opportunities  for  in- 
struction and  tie  them  together  in  one  main  institute  for  research,  ad- 
vanced and  special  instruction,  and  for  co-ordination. 


COLUMBIA   UNIVERSITY 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing,      : 
as  provided  by  the  rules  of  the  I>ibrary  or  by  special  ar- 
rangement with  the  Librarian  in  charge. 

DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

tAAQ 

3?  0*1    Af 

i^aszam 

MAK 

L  W  Lmwt       rt' 

'ifo  \  6^^ 

» 

IM  5^    *  ^ 

/ 

1 

C26I6381M50 

1 

RC963 


C76 


Conference  on  industrial  hygiene, 
N.Y.,  1919 


m 


COLUMBIA  UNIVtRSITY  LIBRARILS 


00.11067460 


